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JAN-21-03 18_41 AM 0x0x0x0xQ 559. 325 2297 P.01 <br /> 001/21/280.1 06'.53 46YE3 EIA11PONHENTAl- !'•4�]SLTH PAGE ' 01 <br /> _ tu�j�oowusmsh <br /> � -� ;i SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES � <br /> Jr+�L�i ry-,)Ii t ENVIRONWN`fAI--.H5ALTH DIVISION ; <br /> 304 EASY W43$ER AVENUb,THIRD I=LOQk <br /> STOtwroN CA 95262 <br /> JAN 2 '.1 2003 . 1 (209)468-3428 <br /> - PUBIC RECORDS RELEASE APPLICATION k <br /> APPUGAl7 DllstNESSIAGEIICY `� <br /> ADDRUSS �, _ .. S YZ �Yf C -r •. . <br /> PKON Irl S r `I _FAc I.R r <br /> TENTATIVE4 APPOINTMENT bAlF. <br /> IPhaav tllrn 7 In 7n husiness Gays from data of upplleNlon submittals ' <br /> -3.3 <br /> Q• t:Fll;6h nox Tfl Fi4Yt-MV srni it,IT'p 40.0a 1=rir. ,nCQULC r nOOLGOCO 1115 E1151IM33 DAYb <br /> *SIGNATURE OF APPLICANT - - � ,�• �` DATE I ��/� � �, "r`• y <br /> fls ADDRESG THIS 51Di i HD STAP USII ONLY <br /> 111i001-AAM ELEVArNTS 59"CH <br /> � G tl'1i d <br /> $G-1 ouJ AcLekS, A` c V- � <br /> 17 <br /> �. <br /> CIClk <br /> EIVVI OI+tM •NTAL HEALTH pNi51 N,t`ILI=S <br /> I NOERGROLIND>iAlt1((uST).CLCANVP SITE flap} OLf5ING ABATCMFNT 3 SCUD <br /> GTHUt CLCANVP SITE(NON-LOP) FOOD FACILITY O bOLIO WASTE VEHitlt <br /> UNOERGRO1,10 TANK(I ONIT64INIGIREMOVAL.) h DOG KEWNSL: ❑,,/DAIRY <br /> .. HAtMt)OUS WMTE Gr-NERATOR Q CNICK104 RANCH <br /> p� PKG TFLEATMEt1T hLANT <br /> TIlaRiU QaRf.IrrTeo CACYInrY O RADTt t/IIpTIC6 c rWrltn TnVAIWAhV10IKM <br /> 0 YATT001000Y MACING 13 POOUSPA D LA►rn VSE APPI,tGAT10N SOTSO, I148DLCA.WAS IF FACILITI OppTHEii(vltAS.SPIEGIRY AoOVE) <br /> n C <br /> -4. List up to tats addresses In the space above. Select the types?of filaa fromhe IPat above Uy clEechi31.f1 <br /> tna appropriate box(es). At laast ant fila type MUSTba selected. F�09f 464-0i38 or m1 ,.r •,, . <br /> address Indicalgd abavl-. <br /> 2.. EHD will notify the apiplicarlt if any END files exist. An appointment for review will be confirmed t..,.:. <br /> approximately five business clays but no later than ton(10)days after rvcolpt of appileallan..T'ha fiiel' <br /> will be hold for a maxlmt;m of five business days for review. Appointments should ba achoduled <br /> 3, A file that is;actively belno wbrkod on by EH.D stair may nal be immediately avaitablc fpr review. Ani <br /> applicAlion may be submitted whan the file is available. v�f. <br /> 4_ Any fila not.roturnod iti'tho cama car►dtlton as rcicaacd will ba rvorpanixad by FHCI fluff at tho vntian; <br /> of thea PPil6ant. Future lila reviews by the samv applicant may requlra a$89.00 deposit prior to rovl ; <br /> 5. 'TENYA'i'tVk appointment Batas must be confirmed with Ef#D staff, <br /> G. Applications recclvad after 3:00 p6n will by procassctl the nuxl business day. <br /> CONFIRMED APPoINT'MENT DATE. _-- _-_ TIME <br /> e DA1'1�GANFIRMI°pPHONE FAX INITIALS <br /> REVIIF.WED YES NO REVIEW DATE <br />